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Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock.
BMJ Open. 2016 07 07; 6(7):e010041.BO

Abstract

OBJECTIVES

Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials.

METHODS

Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey.

RESULTS

A total of 1097 physicians' responses were included. 1 L was the most frequent quantity of resuscitation fluid physicians indicated they would administer at a time (46.9%, n=499). Most (63.0%, n=671) stated that they would administer the fluid challenges as quickly as possible. Overall, normal saline and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said that they would use saline 'often' or 'always' in 27.9% (n=150) of instances. Only 1.0% (n=10) of respondents indicated that they would use hydroxyethyl starch 'often' or 'always'; use of 5% (5.6% (n=59)) or 20-25% albumin (1.3% (n=14)) was also infrequent. The majority (88.4%, n=896) of respondents indicated that a large randomised controlled trial comparing 5% albumin to a crystalloid fluid in early septic shock was important to conduct.

CONCLUSIONS

Critical care and emergency physicians stated that they rapidly infuse volumes of 500-1000 mL of resuscitation fluid in early septic shock. Colloid use, specifically the use of albumin, was infrequently reported. Our survey identifies the need to conduct a trial on the efficacy of albumin and crystalloids on 90-day mortality in patients with early septic shock.

Authors+Show Affiliations

Department of Medicine (Division of Critical Care), University of Ottawa, Ottawa, Ontario, Canada The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada.Department of Anaesthetics, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh, UK.Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.Department of Intensive Care, Ringshospitalet, Copenhagen, Denmark.Department of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, London, UK.Department of Surgery, University of Toronto, Toronto, Ontario, Canada.Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.Faculty of Medicine and Dentistry, Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada Population Health and Optimal Health Practice Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec Research Center, CHU de Québec (Hôpital de l'Enfant-Jésus), Laval, Québec City, Québec, Canada.CancerCare Manitoba, Winnipeg, Manitoba, Canada.Department of Medicine (Division of Critical Care), University of Ottawa, Ottawa, Ontario, Canada The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27388345

Citation

McIntyre, Lauralyn, et al. "Multicountry Survey of Emergency and Critical Care Medicine Physicians' Fluid Resuscitation Practices for Adult Patients With Early Septic Shock." BMJ Open, vol. 6, no. 7, 2016, pp. e010041.
McIntyre L, Rowe BH, Walsh TS, et al. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock. BMJ Open. 2016;6(7):e010041.
McIntyre, L., Rowe, B. H., Walsh, T. S., Gray, A., Arabi, Y., Perner, A., Gordon, A., Marshall, J., Cook, D., Fox-Robichaud, A., Bagshaw, S. M., Green, R., Schweitzer, I., Turgeon, A., Zarychanski, R., English, S., Chassé, M., Stiell, I., & Fergusson, D. (2016). Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock. BMJ Open, 6(7), e010041. https://doi.org/10.1136/bmjopen-2015-010041
McIntyre L, et al. Multicountry Survey of Emergency and Critical Care Medicine Physicians' Fluid Resuscitation Practices for Adult Patients With Early Septic Shock. BMJ Open. 2016 07 7;6(7):e010041. PubMed PMID: 27388345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock. AU - McIntyre,Lauralyn, AU - Rowe,Brian H, AU - Walsh,Timothy S, AU - Gray,Alasdair, AU - Arabi,Yaseen, AU - Perner,Anders, AU - Gordon,Anthony, AU - Marshall,John, AU - Cook,Deborah, AU - Fox-Robichaud,Alison, AU - Bagshaw,Sean M, AU - Green,Robert, AU - Schweitzer,Irwin, AU - Turgeon,Alexis, AU - Zarychanski,Ryan, AU - English,Shane, AU - Chassé,Michaël, AU - Stiell,Ian, AU - Fergusson,Dean, AU - ,, Y1 - 2016/07/07/ PY - 2016/7/9/entrez PY - 2016/7/9/pubmed PY - 2017/12/6/medline KW - Adults KW - Critical Care KW - Emergency Medicine KW - Fluid resuscitation KW - Septic shock KW - Survey SP - e010041 EP - e010041 JF - BMJ open JO - BMJ Open VL - 6 IS - 7 N2 - OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. METHODS: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey. RESULTS: A total of 1097 physicians' responses were included. 1 L was the most frequent quantity of resuscitation fluid physicians indicated they would administer at a time (46.9%, n=499). Most (63.0%, n=671) stated that they would administer the fluid challenges as quickly as possible. Overall, normal saline and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said that they would use saline 'often' or 'always' in 27.9% (n=150) of instances. Only 1.0% (n=10) of respondents indicated that they would use hydroxyethyl starch 'often' or 'always'; use of 5% (5.6% (n=59)) or 20-25% albumin (1.3% (n=14)) was also infrequent. The majority (88.4%, n=896) of respondents indicated that a large randomised controlled trial comparing 5% albumin to a crystalloid fluid in early septic shock was important to conduct. CONCLUSIONS: Critical care and emergency physicians stated that they rapidly infuse volumes of 500-1000 mL of resuscitation fluid in early septic shock. Colloid use, specifically the use of albumin, was infrequently reported. Our survey identifies the need to conduct a trial on the efficacy of albumin and crystalloids on 90-day mortality in patients with early septic shock. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/27388345/Multicountry_survey_of_emergency_and_critical_care_medicine_physicians'_fluid_resuscitation_practices_for_adult_patients_with_early_septic_shock_ DB - PRIME DP - Unbound Medicine ER -